Pathophysiological Study on the Mechanism of Whiplash Shaking Injury

摇晃婴儿综合征（SBS）是最常见的死亡或严重神经损伤的原因，其特征是颅内出血和进行性脑萎缩，由虐待儿童引起。然而，其特征性病变，如急性硬膜下血肿、眼出血和脑萎缩是否仅由摇头引起仍不清楚。在本研究中，我们建立了幼年大鼠SBS模型，以探讨脑损伤的病理生理机制。将3 ~ 4周龄的大鼠用加速度计以10 G的加速度以300次/min的速度剧烈摇晃头部10分钟，动物出现严重的发绀和呼吸暂停，约20%的动物死亡。虽然摇晃后立即测量的血氧水平的降低是短暂的，并且在约10分钟后恢复，但脑氧水平和脑血流量的降低持续30分钟或更长时间。将5只6日龄大鼠连续摇晃3天，观察大鼠的行为变化。 关于我们 3周后，体重和脑重均显著低于对照组。冰冻切片，HE、Fe染色，免疫组化ABC法（抗GFAP、抗β APP）。在摇晃组的3例病例中，观察到轻度蛛网膜下腔出血。然而，在脑和颈脊髓中未观察到其他异常，包括实质出血和梗死。免疫组化染色也没有发现任何异常，如反应性星形胶质细胞和轴突变性。虽然这项研究未能找到关于脑损伤是否仅由摇晃引起的病理学结论，但需要进一步研究，因为从脑重量的减少来判断，脑中可能会出现某种异常。此外，这是强烈建议，缺氧可能是一个非常真实的二次侮辱在SBS，这有助于加剧脑损伤，由于主要的机械损伤的震动。少

Shaken Baby Syndrome (SBS) is the most common cause of death or serious neurological injury characterized by intracranial hemorrhage and progressive brain atrophy, resulting from child abuse. However, it is still unknown whether the characteristic lesions, such as acute subdural hematoma, ocular hemorrhage and cerebral atrophy are caused by shaking head alone. In this study, we developed a infant rat model of SBS to investigate the pathophysiological mechanisms underlying the brain damage. When heads of 3 or 4 week old rats with accelerometers were violently shaken 300 times/min at the acceleration of 10G for 10 minutes, the animals developed serious cyanosis and apnea, and about 20% of them died. Although decrease in the blood oxygen level measured immediately after shaking was transient and recovered about 10 minutes later, decline in the cerebral oxygen level and cerebral blood flow persisted for 30 minutes or longer. Five 6 day old rats were shaken for three consecutive days, and t … More hree weeks after that, the body weight and brain weight of them were significantly lower than those of controls. Frozen sections of brains that had been kept for three weeks after shaking were stained with HE and Fe and immunohistochemical staining, ABC method (antiGFAP, anti β APP). In three cases of the shaken group, mild subarachnoid hemorrhage were noticed. However, no other abnormalities including parenchymal hemorrhage and infarction were noted in the brain and cervical spinal cord. Neither did the immunohistchemical staining reveal any abnormalities such as reactive astrocyte and axonal degeneration. Although this study failed to find a pathological conclusion as to if brain damage is caused by shaking alone, further investigation is required since some kind of abnormalities might occur in the brain, judging from decrease in the brain weight. In addition, it is strongly suggested that hypoxia may be a very real secondary insult in SBS, which serves to exacerbate brain damage due to the primary mechanical injury of shaking. Less